Sara J. Martinez

Athletes are known for playing through injuries, and a new study presented Monday at the RSNA annual meeting says that sometimes it’s safe for them to push through pain. 

 Researchers reported the effects of long-distance running on the body by using a mobile MRI truck to follow runners across Europe for two months in the 4488-kilometer TransEurope Foot Race. Over the course of the 64-day long-distance race, researchers collected daily urine samples and biometric data as well as blood samples from 22 of the 66 runners. Participants underwent an MRI exam every three or four days.

The study found athletes lost body volume and body fat and their leg muscles degenerated over time because of their immense energy consumption.

 “Our primary work was the MRI,” said Dr. Uwe Schütz, a specialist in orthopedics and trauma surgery in the diagnostic and interventional radiology department at the University Hospital of Ulm in Germany. “We were able to do 10 to 12 MRI examinations a day.”

 MR images of therunners’ bodies showed they lost an average of 5.4% body volume from start to finish, most of which took place in the first half of the race. Schütz said men lost about 5 kg of body fat during the race.

 Nearly all runners had some problem with their legs, including muscle and tendon inflammation.

“Reasons for giving up the race and not finishing were twofold,” Schütz said. “Mostly severe and recurrent overuse and inflammation of soft tissue in the legs.”

But Schütz said these runners handled pain differently than most nonrunners or recreational runners, and many would not give up.

“These athletes have a significantly different pain perception than normal people and a strikingly high pain level,” he said. “If they get problems in their body, they will not stop because they want to finish. They will run through the pain.”

Some pain is OK to run through, and Schütz said pushing through pain from soft tissue inflammation has no lasting effects.

“The rule that ‘if there is pain, you should stop running’ is not always correct,” Schütz said. “It’s necessary to find the reason for pain, and you don’t have to tell the runner ‘You have to stop.’”

MRI scans also showed a reduction of more than 5% of brain volume during the course of the study, Schütz said. The main loss of volume was in the region of the brain where areas of optical associations are located, but subjects tested later found their brains had gone back to normal.

Schütz said this could have been because the course went through a forest for four weeks of the race.

“We think that the optical area wasn’t needed at this time,” he said. “It was very monotone, so maybe the body has a tendency to decrease in this area because it’s not needed.”

The study also found the first tissue affected was visceral fat, and visceral fat loss occurred earlier in the process than previously thought. Fat reduction is more pronounced in people as they begin running rather than in those who’ve been running for a long time, Schütz said.

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Athletes are known for playing through injuries, and a new study presented Monday at the RSNA annual meeting says that sometimes it’s safe for them to push through pain.

Mobile MRI tracks effects of long-distance running

Walking may slow the progression of Alzheimer’s disease and mild cognitive impairment in healthy and cognitively impaired adults, according to a study presented Monday at the RSNA annual meeting. A separate study found walking and other light physical activity delays the onset or altogether prevents osteoarthritis.

“Physical activity really has the power to preserve brain volume with normal aging and reduce the risk for future cognitive impairment,” said Cyrus Raji, Ph.D., from the radiology department at the University of Pittsburgh and lead author of the Alzheimer’s study.

Engaging in light exercise had positive results in preventing osteoarthritis in a study by Dr. Thomas Link, a professor of radiology and chief of musculoskeletal imaging at the University of California, San Francisco.

In the Alzheimer’s study, Raji and his colleagues focused on a sampling of 426 people from a 20-year ongoing cardiovascular health study that began with about 1500 subjects in Pittsburgh in 1989.

The study used high-resolution 3D volumetric MRI scans of the brain to analyze the relationship between physical activity and brain structure in 299 healthy adults and 127 cognitively impaired adults, 83 with mild cognitive impairment and 44 with Alzheimer’s disease.

The study found that healthy adults walking six miles per week preserved brain volume over 10 years and reduced the risk of Alzheimer’s disease by 50%.

The results were similar for the cognitively impaired group, but they didn’t have to walk as much.

“Walking a slightly smaller amount, five miles per week, reduces brain atrophy and neurodegeneration over time and reduces cognitive decline and memory loss by more than 50% over 10 years,” Raji said.

There is no cure for Alzheimer’s disease, but the study supports the idea that physical activity may be an effective way to reduce the risk and preserve brain volume by strengthening brain structure.

The osteoarthritis study also found physical activity is beneficial, though too much physical activity appears to be associated with more degenerated cartilage and a higher risk for developing osteoarthritis, Link said.

“Weight-bearing activity is essential for normal cartilage development, but excessive loading may lead to degeneration over time,” said Keegan Hovis, a research associate in the radiology department at UCSF.

In both the risk-factor group and the normal group, the study found frequent knee-bending activities were associated with more degenerated cartilage at the molecular level, Hovis said.

Researchers studied 132 asymptomatic subjects at risk for knee osteoarthritis and grouped them according to exercise levels: sedentary, light exercisers, and moderate to strenuous exercisers. They also grouped them into strength-training levels: none, minimal, and frequent.

Women who participated in moderate-to-strenuous physical activity had greater cartilage degeneration at the molecular level than the men who were studied.

Link said it is important for patients to keep their joints active but not to overdo it.

“We have to advise patients that they should perform light exercise, which is important to keep the joints moving,” he said.

The safest choice for maintaining healthy cartilage is light exercise, particularly frequent walking, according to Hovis.

Walking may slow the progression of Alzheimer’s disease and mild cognitive impairment in healthy and cognitively impaired adults, according to a study presented Monday at the RSNA annual meeting. A separate study found walking and other light physical activity delays the onset or altogether prevents osteoarthritis

Walking, light exercise may prevent Alzheimer’s, osteoarthritis

Not knowing your test results can be more stressful than actually having a confirmed diagnosis, according to a study presented Nov. 29 at the RSNA annual conference. The uncertainty patients experience in the waiting room is as serious a stressor as knowing they have a malignant disease, the researchers found.

“We found this uncertainty is one of the most challenging parts, because once you know what the diagnosis is, you can plan,” said lead author Dr. Elvira Lang, an associate professor of radiology at Harvard Medical School. “Psychologically, that is much easier to bear than hanging in the air.”

There really is no such thing as just a diagnostic test, she said. The uncertainty is more stressful than awaiting risky treatment, she said.

Lang and her colleague, Nicole Flory, Ph.D., studied stress levels in 214 women scheduled for different diagnostic and treatment procedures. They measured stress and anxiety levels with four standardized tests: the State Trait Anxiety Inventory, Impact of Events Scale, Center for Epidemiological Studies Depression Scale, and Perceived Stress Scale.

The study found the patients who were most stressed were the 112 women awaiting breast biopsy. They had an average score of 48 out of 80 on the State Trait Anxiety Inventory, where patients rate their comfort level while waiting for a procedure.

The 42 women awaiting hepatic chemoembolization for liver cancer had an average score of 26, while the 60 awaiting uterine fibroid embolization for uterine myoma had an average score of 24.

“The women who came for diagnosis of breast cancer were significantly more stressed than even women who came in for chemoembolization,” Lang said.

Scores for the other three standardized tests weren’t much different, with the highest stress ratings coming from breast biopsy patients.

While the study sampled only women, men experience the same anxiety, Lang said.

“There are similar models published on the effect of stress hormones for men undergoing prostate biopsy,” she said. “For men, if they don’t know what the diagnosis is, they are more stressed than if they are told they have cancer.”

Lang said the good news is that doctors can learn to alleviate the stress of patients coming in for diagnostic procedures by using language that is more helpful for the patient and frames the experience in a better way.

“Don’t give negative suggestions like, ‘This hurts,’ ‘It’s gonna sting,’ ‘It’s not that bad.’ That is the one thing we published that gives patients more pain and more anxiety,” Lang said.

Since concluding the study, Lang started a company that coaches professionals and patients in dealing with anxiety associated with diagnostic tests. She also wrote a book, 

Not knowing your test results can be more stressful than actually having a confirmed diagnosis, according to a study presented Nov. 29 at the RSNA annual conference. The uncertainty patients experience in the waiting room is as serious a stressor as knowing they have a malignant disease, the researchers found.

Sara J. Martinez

Articles

Mobile MRI tracks effects of long-distance running

Walking, light exercise may prevent Alzheimer’s, osteoarthritis

Uncertain test results provoke more anxiety than malignant disease